Archive for the ‘Stoler, Diane & Hill, Barbara’ Category

This is an excellent resource for those who have suffered from concussion, or closed head injury and for those professionals working with such people.  I would quite like to own a copy so that I could lend it to head-injured people I work with.

Having said that, if I owned a copy, I would be tempted to take the scissors to some parts of it!

OK then, the good points: 

Comprehensive, easy to read, a wealth of information, great diagrammes showing how brain injury can happen.  The book consists of five broad sections:  An Overview; Physical Aspects; Mental Aspects; Emotional Aspects and Recovering.  There is also a glossary, resources and references for further reading.  Each category is broken down to cover topics like headaches, sexuality, vision problems, muscular/motor problems, memory etc etc.  There are sections for each identified problem on diagnostics, conventional treatment, alternative approaches and practical suggestions.  Subject to some of my gripes below, the information is easy to follow, and there is an enormous amount of good practical advice.  (And reality based advice – the principal author suffered a concussion head injury herself.) 

I think it is great to see comprehensive information on alternative approaches, like acupressure, acupuncture, massage, vitamins, homeopathy and the like.  Doubtless many experts, particularly those who are conventionally medically trained will harrumph about this, but too bad !  If people find these approaches helpful, well and good, I say.   (If I happened to have a head injury, I would make sure I took Co-enzyme Q10, Vitamin E, Magnesium and got plenty of vitamin D via sunlight.)

The not so good parts?  Well these are not so bad as to detract from the overall value of the book – more like the occasional puzzling item that has the potential to confuse or mislead.

I absolutely DO NOT like the term “mild” traumatic brain injury.  Some of these injuries are anything but mild and this is obvious from reading the case studies in the book.  This is hardly the authors’ fault, I guess, they are doubtless repeating a term that has become current in the US.  I had never heard of it until I saw it in the book and my work colleagues feel the same way about it.  The word mild has an enormous potential to mislead those who do not have a knowledge of head injury.  (Well … you’ve had a mild head injury, what’s the problem?  Get over it!)  Concussion or Closed Head Injury are much better terms and are more universally understood. 

There are lists of medications that are very outdated and of dubious value for their stated purpose.  Some examples: Who, nowadays uses Nardil (an anti-depressant with dangerous side-effects?  And Thorazine, Haldol and Navane for headaches??  These are potent anti-psychotics with horrendous side effects and their use for any sort of pain would be very dubious indeed. 

The principal author describes herself as a neuropsychologist, but throughout the book there are statements that a neuropsychologist should not be making.  There seems to be some confusing mingling of neuropsychological testing and personality testing.  Personality testing is not useful in neuropsychology. 

In places there is a shot-gun approach to problems, where, it seems, every disorder known to man is listed in conjunction with head injury.  Some of the connections made need to be taken with the proverbial grain of salt.  This has the potential to confuse and mislead. 

I think the book could do with a good editing in relation to these matters, but as stated above, they are relatively minor when compared to the wealth of good information and I would still like to have my own copy.

Additional information for those who are interested:

1.  In the book, it is suggested that if you are looking for a professional, you check their qualifications, how many head injured clients they have had, the journals they subscribe to, their professional associations, etc.  I don’t know how practical this is ?  Perhaps in the US ?  I suspect that in most circumstances, particularly if you are fronting up to the public health system, you probably won’t have this luxury.  I would suggest you would be better off trying to make sure you see someone who has empathy, a willingness to explore options with you and a willingness to challenge their own assumptions, training etc.  You could find someone with all the bells and whistles who is cold, clinical and arrogant.  If you start off by stating your symptoms and the person seeing you looks puzzled, tells you they can’t understand why it would be like that and perhaps suggests/implies it is “all in your head” – look elsewhere.

2.  There is an old saying in medicine – don’t make assumptions.  This can be applied when dealing with the medical and allied professions too !  Don’t assume that your doctor knows about head injury and its consequences.  Don’t assume that specialist physicians know either.  Don’t assume that psychiatrists know about head injury – they often don’t.  Don’t assume a neurologist will know.  Don’t assume that all psychologists know, or are qualified to investigate. 

 A couple of years ago, a young man was referred to me, he had been hit on the head at work and even though he was wearing a safety helmet, he was knocked to the ground stunned.  Three years later he was still having a substantial number of symptoms – fierce headaches, memory problems, sleep disturbances, noise intolerance, light intolerance, tiredness, difficulty processing information etc.  He had seen numerous doctors and specialists, who all professed to be puzzled, he had been denied insurance and injury compensation.  When he told me this, before we got anywhere near testing, I told him he had had a concussion and likely had post-concussion syndrome.  He looked at me quizzically and said “What’s concussion?”  Amazing!  He had seen doctors and specialists galore and no-one had recognised concussion and post-concussion syndrome. 

3.  Beware those who would over-test.  Some professionals just love to issue tests.  They would issue and recommend every test known to man.  There needs to be a point to testing, it needs to be for your benefit.  If you have had a head injury, testing, even the routine required testing, can be utterly exhausting.  (Take someone with you who can drive you home.)  Testing should demonstrate your  abilities and your deficits and should inform a programme, or advice as to what you can do to manage deficits. 

Two tests which are often used as a starting point in neuropsycholgical assessment at the Wechsler Adult Intelligence Scale (WAIS) and the Wechsler Memory Scale (WMS.)  The WMS, fairly obviously tests various aspects of memory.  The WAIS is an IQ test, but the purpose is not just to obtain an IQ score.  Each of the test sub-scales makes some assessment of a partcular brain function – memory, speed of information processing, ability to manipulate information, sequential reasoning etc.  The outcomes of these tests may suggest the need for further investigation, but as I state above, testing should not just go on and on.  Remember, at the end of it all, you will still have to manage your symptoms. 

It seems to be popular in the US to mix personality testing into neuropsychological testing.  I am an old fashioned neuropsychologist and regard this as a waste of time.  The book mentions a test called the MMPI (Minnesota Multiphasic Personality Inventory.)  It has always been controversial.  I think it would be much more useful if it was printed on tissue paper.

4.  Beware the use of alcohol and other drugs.  (I don’t think the book covers this well.)  Some people try to drink as they did before they had a head injury, only to find that even small amounts of alcohol absolutely flatten them.  Some, I have known, have tried stimulants such as methamphetamine and cocaine to try to pick themselves up, but this too is disastrous.  These substances cause brain cell damage at the best of times and losing more brain cells after a head injury is the last thing you need. 

Cannabis can give the illusion of being helpful, but again, this substance clouds consciousness at the best of times and that is not what you need.

Be cautious of drugs of the Valium family.  They can make you feel better but there is a price if they are used too long.  They are very addictive and the addiction is hard to shake.  They should only be prescribed as a short-term measure. 

Unfortunately there are no medications that can repair brain injury.  Only time and self-care can do that, though as stated in the book, natural healing methods, supplements and nutrition may be helpful.

5.  Brain injury effects can be cumulative.  Many people get a head injury through contact sport and return to their game of choice as soon as they feel better.  If they get another head injury, the effects tend to be worse and longer lasting.   And the next one … well, you get the picture.

6.  Most people who have a concussion, or so-called “mild” brain injury recover fairly well within a few months.  Some, however, don’t either because the damage was more severe, or for reasons we don’t really understand.  One of the most distressing things about head injury with long lasting effects is that sufferers start to think they are going crazy, or losing their mind, or begin to despair of ever getting well again.  If this applies to you, you may need some assistance dealing with the stress that this causes.  Getting in touch with a brain injury association, or a knowledgeable counsellor may help.


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